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Wilda Rinehart received an Associate Degree in Nursing from Northeast Mississippi Community College in Booneville, Mississippi. After working as a staff nurse and charge nurse, she became a public health nurse and served in that capacity for a number of years. In 1975, she received her nurse practitioner certification in the area of obstetrics-gynecology from the University of Mississippi Medical Center in Jackson, Mississippi. In 1979, she completed her Bachelor of Science degree in Nursing from Mississippi University for Women. In 1980, she completed her Master of Science degree in Nursing from the same university and accepted a faculty position at Northeast Mississippi Community College, where she taught medical-surgical nursing and maternal-newborn nursing. In 1982, she founded Rinehart and Associates Nursing Consultants. For the past 26 years, she and her associates have worked with nursing graduates and schools of nursing to assist graduates to pass the National Council Licensure Exam for Nursing. She has also worked as a curriculum consultant with faculty to improve test construction. Ms. Rinehart has served as a convention speaker throughout the southeastern United States and as a reviewer of medical-surgical and obstetric texts. She has co-authored materials used in seminars presented by Rinehart and Associates Nursing Review. As the president of Rinehart and Associates, she serves as the coordinator of a company dedicated to improving the quality of health through nursing education.
Dr. Diann Sloan received an Associate Degree in Nursing from Northeast Mississippi Community College, a Bachelor of Sience degree in Nursing from the University of Mississippi, and a Master of Science degree in Nursing from Mississippi University for Women. In addition to her nursing degrees, she holds a Master of Science in Counseling Psychology from Georgia State University and a Doctor of Philosophy in Counselor Education , with minors in both Psychology and Educational Psychology, from Mississippi State University. She has completed additional graduate studies in healthcare administration at Western New England College and the University of Mississippi. Dr. Sloan has taught pediatric nursing, psychiatric mental health nursing, and medical surgical nursing in both associate degree and baccalaureate nursing programs. As a member of Rinehart and Associates Nursing Review, Dr. Sloan has conducted test construction workshops for faculty and nursing review seminars for both registered and practical nurse graduates. She has co-authored materials used in the item-writing workshops for nursing faculty and Rinehart and Associates Nursing Review. She is a member of Sigma Theta Tau nursing honor society.
Clara Hurd received an Associate Degree in Nursing from Northeast Mississippi Community College in Booneville, Mississippi (1975). Her experiences in nursing are clinically based, having served as a staff nurse in medical-surgical nursing. She has worked as an oncology, intensive care, orthopedic, neurological, and pediatric nurse. She received her Bachelor of Science degree in Nursing from the University of North Alabama in Florence, Alabama, and her Master of Science degree in Nursing from the Mississippi University for Women in Columbus, Mississippi. Ms Hurd is a certified nurse educator. She currently serves as a nurse educator consultant and an independent contractor. Ms. Hurd has taught in both associate degree and baccalaureate degree nursing programs. She was a faculty member of Mississippi University for Women; Austin Peay State University in Clarksville, Tennessee; Tennessee State University in Nashville, Tennessee; and Northeast Mississippi Community College. Ms. Hurd joined Rinehart and Associates in 1993. She has worked with students in preparing for the National Council Licensure Exam and with faculty as a consultant in writing test items. Ms. Hurd has also been a presenter at nursing conventions on various topics, including item-writing for nursing faculty. Her primary professional goal is to prepare the student and graduate for excellence in the delivery of healthcare.
Introduction..................................................................................................xxiii
Welcome to the NCLEX-PN® Exam Cram ..............................................................xxiii
Taking the Computerized Adaptive Test ......................................................................xxiv
The Cost of the Exam...................................................................................................xxiv
How to Prepare for the Exam........................................................................................xxv
How to Use This Book ..................................................................................................xxv
About the Book.............................................................................................................xxvii
Contact the Authors .....................................................................................................xxvii
Self-Assessment................................................................................................1
Testing Your Exam Readiness............................................................................................2
CHAPTER 1
Preparing for the National Council Exam for Licensed Practical Nurses..............................3
Preparing for the Exam .....................................................................................................4
The Computer Adaptive Test ..................................................................................4
Testing Strategies......................................................................................................5
Reading the Question Carefully ..............................................................................6
Look for Keywords...................................................................................................6
Watch for Specific Details........................................................................................6
Exam Prep Questions ........................................................................................................9
Answer Rationales...................................................................................................11
CHAPTER 2
Simplifying Pharmacology ..................................................................................13
Pharmacology...................................................................................................................14
Three Areas of Pharmacology ...............................................................................14
How Nurses Work with Pharmacology..........................................................................15
Time-Released Drugs.............................................................................................16
Administering Medications ....................................................................................17
Understanding and Identifying the Various Drugs ........................................................18
Angiotensin-Converting Enzyme Inhibitors .........................................................18
Beta Adrenergic Blockers .......................................................................................19
Anti-Infectives (Aminoglycosides) .........................................................................20
Benzodiazepines (Anticonvulsants/Antianxiety) ....................................................22
Phenothiazines (Antipsychotic/Antiemetic) ..........................................................24
Glucocorticoids.......................................................................................................25
Antivirals .................................................................................................................26
Cholesterol-Lowering Agents................................................................................28
Angiotensin Receptor Blockers..............................................................................29
Histamine 2 Antagonists ........................................................................................30
Proton Pump Inhibitors .........................................................................................31
Anticoagulants ........................................................................................................32
More Drug Identification Helpers ........................................................................33
Herbals .............................................................................................................................34
Drug Schedules................................................................................................................35
Pregnancy Categories for Drugs.....................................................................................35
Exam Prep Questions ......................................................................................................36
Answer Rationales...................................................................................................38
CHAPTER 3
Caring for the Client with Disorders of the Respiratory System ......................................41
Chronic Obstructive Pulmonary Disease .......................................................................42
Chronic Bronchitis .................................................................................................42
Emphysema.............................................................................................................42
Asthma ....................................................................................................................43
Acute Respiratory Infections ...........................................................................................44
Pneumonia ..............................................................................................................44
Pleurisy....................................................................................................................45
Tuberculosis ............................................................................................................46
Influenza .................................................................................................................46
Emerging Infections ........................................................................................................47
Severe Acute Respiratory Syndrome .....................................................................47
Legionnaire’s Disease .............................................................................................48
Diagnostic Tests for Review ............................................................................................49
Pharmacology Categories for Review .............................................................................49
Exam Prep Questions ......................................................................................................50
Answer Rationales...................................................................................................52
Suggested Reading and Resources ..................................................................................53
CHAPTER 4
Caring for the Client with Disorders of the Renal and Genitourinary System ......................55
Acute Glomerulonephritis...............................................................................................56
Chronic Glomerulonephritis...........................................................................................57
End Stage Renal Disease .................................................................................................58
Peritoneal Dialysis ..................................................................................................58
Hemodialysis...........................................................................................................58
Renal Transplantations ...........................................................................................59
Nephrotic Syndrome .......................................................................................................59
Urinary Calculi ................................................................................................................60
Urinary Tract Infections..................................................................................................60
Genitourinary Disorders .................................................................................................61
Prostatitis ................................................................................................................61
Benign Prostatic Hyperplasia ..........................................................................................62
Bladder Cancer ................................................................................................................63
Diagnostic Tests for Review ............................................................................................64
Pharmacology Categories for Review .............................................................................64
Exam Prep Questions ......................................................................................................65
Answer Rationales...................................................................................................67
Suggested Reading and Resources ..................................................................................68
CHAPTER 5
Caring for the Client with Disorders of the Hematopoietic System...................................69
Anemia.............................................................................................................................70
Pernicious Anemia..................................................................................................70
Aplastic Anemia ......................................................................................................71
Sickle Cell Anemia .................................................................................................72
Iron Deficiency Anemia .........................................................................................73
Cooley’s Anemia (Thalassemia Major) ..................................................................73
Hemophilia ......................................................................................................................73
Polycythemia Vera ...........................................................................................................74
Diagnostic Tests for Review ............................................................................................75
Pharmacology for Review................................................................................................75
Exam Prep Questions ......................................................................................................76
Answer Rationales...................................................................................................78
Suggested Reading and Resources ..................................................................................79
CHAPTER 6
Caring for the Client with Disorders of Fluid and Electrolyte Balance and Acid/Base Balance ..81
Basic Knowledge of Fluid and Electrolyte Balance........................................................82
Regulation of pH and Its Effect on Fluid and Electrolytes ...........................................83
How the Body Regulates pH .................................................................................83
Metabolic Acidosis ...........................................................................................................83
Causes of Metabolic Acidosis.................................................................................83
Symptoms of Metabolic Acidosis...........................................................................84
Care of the Client with Metabolic Acidosis ..........................................................84
Respiratory Acidosis.........................................................................................................85
Causes of Respiratory Acidosis ..............................................................................85
Symptoms of Respiratory Acidosis ........................................................................86
Caring for the Client with Respiratory Acidosis...................................................86
Metabolic Alkalosis ..........................................................................................................87
Causes of Metabolic Alkalosis ................................................................................87
Symptoms of Metabolic Alkalosis ..........................................................................87
Caring for the Client with Metabolic Alkalosis ....................................................88
Respiratory Alkalosis........................................................................................................88
Symptoms of Respiratory Alkalosis........................................................................88
Care of the Client with Respiratory Alkalosis.......................................................89
Normal Electrolyte Values ..............................................................................................89
Changes Associated with Aging ......................................................................................90
Exam Prep Questions ......................................................................................................91
Answer Rationales...................................................................................................93
Suggested Reading and Resources ..................................................................................94
CHAPTER 7
Caring for the Client with Burns ............................................................................95
Burn Classifications .........................................................................................................96
Burn Measurement with TBSA .............................................................................98
Nursing Care for Burn Victims.......................................................................................99
The Emergent Phase............................................................................................100
The Intermediate Phase .......................................................................................104
Dressings for Burns ..............................................................................................105
The Rehabilitative Phase......................................................................................106
Diagnostic Tests for Review ..........................................................................................106
Pharmacology Categories for Review ...........................................................................106
Exam Prep Questions ....................................................................................................108
Answer Rationales.................................................................................................110
Suggested Reading and Resources ................................................................................111
CHAPTER 8
Caring for the Client with Sensorineural Disorders....................................................113
Disorders of the Eyes ....................................................................................................114
Intraocular Disorders ...........................................................................................114
Retinal Disorders..................................................................................................117
Refractive Errors ..................................................................................................119
Traumatic Injuries ................................................................................................120
Visual Tests for Review..................................................................................................121
Pharmacology Categories for Review ...........................................................................121
Ear Disorders .................................................................................................................121
Otitis Externa........................................................................................................122
Otitis Media ..........................................................................................................122
Meniere’s Disease .................................................................................................122
Otosclerosis...........................................................................................................123
Presbycusis ............................................................................................................123
Ear Trauma ...........................................................................................................124
Assisting Clients with Hearing Loss .............................................................................124
Diagnostic Tests for Review ..........................................................................................124
Pharmacology Categories for Review ...........................................................................125
Exam Prep Questions ....................................................................................................126
Answer Rationales.................................................................................................128
Suggested Reading and Resources ................................................................................129
CHAPTER 9
Caring for the Client with Cancer .........................................................................131
Cancer ............................................................................................................................132
American Cancer Society’s Seven Warning Signs of Cancer..............................132
The Four Major Categories of Cancer................................................................132
Risk Factors for Specific Cancers ........................................................................133
Cancer Prevention................................................................................................134
Patient Teaching ...................................................................................................135
Management of the Client with Cancer .......................................................................135
Radiation...............................................................................................................136
Chemotherapy ......................................................................................................137
Bone Marrow Transplantation and Peripheral Stem Cell Transplantation (PSCT)...139
Types of Transplants.............................................................................................139
Nursing Care After Transplantation....................................................................140
Hodgkin’s Lymphoma ...................................................................................................141
Diagnosis of Hodgkin’s Lymphoma.....................................................................141
Prognosis of Hodgkin’s Lymphoma.....................................................................142
Treatment of Hodgkin’s Lymphoma....................................................................142
Diagnostic Tests for Review ..........................................................................................142
Pharmacology for Review..............................................................................................143
Exam Prep Questions ....................................................................................................145
Answer Rationales.................................................................................................147
Suggested Reading and Resources ................................................................................148
CHAPTER 10
Caring for the Client with Disorders of the Gastrointestinal System................................151
Ulcers .............................................................................................................................152
Types of Ulcers .....................................................................................................152
Treatment of Ulcers .............................................................................................153
Inflammatory Bowel Disorders .....................................................................................155
Crohn’s Disease (Regional Enteritis) ...................................................................155
Ulcerative Colitis..................................................................................................156
Diverticulitis..................................................................................................................157
Diagnosis of Diverticulitis....................................................................................157
Treatment of Diverticulitis...................................................................................157
Gastroesophageal Reflux Disease (GERD) ..................................................................158
Diseases Associated with the Liver ...............................................................................159
Hepatitis................................................................................................................159
Cirrhosis................................................................................................................164
Pancreatitis............................................................................................................166
Cholecystitis/Cholelithiasis ...........................................................................................168
Symptoms of Cholecystitis and Cholelithiasis ....................................................168
Diagnosis of Cholecystitis/Cholethiasis ..............................................................169
Treatment of Cholecystitis ...................................................................................169
Treatment of Cholecystitis ...................................................................................169
Diagnosis of Cholecystitis/Cholethiasis ..............................................................170
Treatment of Cholethiasis ....................................................................................170
Clostridium Difficile......................................................................................................171
Food-Borne Illnesses .....................................................................................................172
Diagnostic Tests for Review ..........................................................................................173
Pharmacology for Review..............................................................................................173
Exam Prep Questions ....................................................................................................175
Answer Rationales.................................................................................................177
Suggested Reading and Resources ................................................................................178
CHAPTER 11
Caring for the Client with Disorders of the Musculoskeletal System ...............................179
Fractures........................................................................................................................180
Treating Fractures ................................................................................................180
Compartment Syndrome......................................................................................183
Osteomyelitis ........................................................................................................184
Osteoporosis...................................................................................................................185
Treatment of Osteoporosis...................................................................................186
Gout ...............................................................................................................................186
Treatment of the Client with Gout .....................................................................187
Rheumatoid Arthritis.....................................................................................................188
Treatment of Rheumatoid Arthritis .....................................................................188
Musculoskeletal Surgical Procedures ............................................................................189
Fractured Hip and Hip Replacement ..................................................................189
Total Knee Replacement ......................................................................................190
Amputations..........................................................................................................191
Assistive Devices for Ambulation ..................................................................................192
Crutches................................................................................................................193
Canes.....................................................................................................................193
Walkers .................................................................................................................194
Diagnostic Tests for Review ..........................................................................................194
Pharmacology for Review..............................................................................................195
Exam Prep Questions ....................................................................................................197
Answer Rationales.................................................................................................199
Suggested Reading and Resources ................................................................................200
CHAPTER 12
Caring for the Client with Disorders of the Endocrine System .......................................201
Pituitary Disorders.........................................................................................................202
Tumors of the Pituitary ........................................................................................202
Thyroid Disorders .........................................................................................................203
Hypothyroidism....................................................................................................203
Hyperthyroidism ..................................................................................................204
Parathyroid Disorders ...................................................................................................206
Hypoparathyroidism.............................................................................................206
Hyperparathyroidism ...........................................................................................207
Adrenal Gland Disorders...............................................................................................208
Adrenocortical Insufficiency (Addison’s Disease) ................................................208
Adrenocortical Hypersecretion (Cushing’s Syndrome).......................................209
Diabetes Mellitus ...........................................................................................................209
Diagnostic Tests for Review ..........................................................................................212
Pharmacology Categories for Review ...........................................................................213
Exam Prep Questions ....................................................................................................214
Answer Rationales.................................................................................................216
Suggested Reading and Resources ................................................................................217
CHAPTER 13
Caring for the Client with Disorders of the Cardiovascular System.................................219
Hypertension..................................................................................................................220
Medications Used to Treat Hypertension ...........................................................221
Heart Block ....................................................................................................................221
Toxicity to Medications ........................................................................................223
Malfunction of the Conduction System ..............................................................223
Myocardial Infarction ....................................................................................................225
Diagnosis of Myocardial Infarction .....................................................................226
Management of Myocardial Infarction Clients ...................................................226
Buerger’s Disease ...........................................................................................................229
Thrombophlebitis..........................................................................................................229
Raynaud’s Syndrome......................................................................................................230
Aneurysms ......................................................................................................................230
Congestive Heart Failure ..............................................................................................231
Diagnostic Tests for Review.................................................................................232
Pharmacology Categories for Review ...........................................................................232
Exam Prep Questions ....................................................................................................233
Answer Rationales.................................................................................................235
Suggested Reading and Resources ................................................................................236
CHAPTER 14
Caring for the Client with Disorders of the Neurological System ...................................237
Seizures..........................................................................................................................238
Types of Seizures ..................................................................................................238
Treatment of Seizure Clients ...............................................................................240
Status Epilepticus...........................................................................................................241
Brain Injuries..................................................................................................................241
Epidural Hematomas............................................................................................242
Subdural Hematoma.............................................................................................242
Treatment of Epidural and Subdural Hematomas ..............................................242
Increased Intracranial Pressure .....................................................................................243
Treatment of ICP .................................................................................................245
Neurological Assessment...............................................................................................245
Cranial Nerve Assessment....................................................................................246
Glasgow Coma Scale............................................................................................247
Intracranial Pressure Monitors ............................................................................248
Care of the Client with Intracranial Surgery (Craniotomy) ........................................248
Cerebrovascular Accident/Stroke..................................................................................249
Spinal Cord Injury .........................................................................................................250
Treatment of Spinal Cord Injuries.......................................................................251
Potential Complications with SCI Clients ..........................................................252
Guillain-Barré ................................................................................................................253
Treating Clients with Guillian-Barré...................................................................253
Degenerative Neurological Disorders ..........................................................................253
Diagnostic Tests for Review ..........................................................................................255
Pharmacology for Review..............................................................................................255
Exam Prep Questions ....................................................................................................257
Answer Rationales.................................................................................................259
Suggested Reading and Resources ................................................................................260
CHAPTER 15
Caring for the Client with Psychiatric Disorders .......................................................261
Anxiety-Related Disorders ............................................................................................262
Generalized Anxiety Disorder..............................................................................262
Post-traumatic Stress Disorder ............................................................................263
Dissociative Identity Disorder .............................................................................263
Somatoform Disorder...........................................................................................264
Panic Disorder ......................................................................................................264
Phobic Disorders ..................................................................................................265
Obsessive-Compulsive Disorder ..........................................................................265
Personality Disorders ....................................................................................................266
Cluster A ...............................................................................................................266
Cluster B ...............................................................................................................267
Cluster C...............................................................................................................268
Managing Clients with Personality Disorders ....................................................269
Psychotic Disorders .......................................................................................................270
Schizophrenia .......................................................................................................270
Bipolar Disorders..................................................................................................272
Substance Abuse.............................................................................................................274
Alcoholism ............................................................................................................274
Other Commonly Abused Substances .................................................................277
Disorders of Childhood and Adolescence.....................................................................279
Conduct Disorder.................................................................................................279
Oppositional Defiant Disorder ............................................................................279
Attention Deficit Hyperactive Disorder..............................................................280
Autistic Disorder...................................................................................................280
Eating Disorders...................................................................................................281
Diagnostic Tests for Review ..........................................................................................281
Pharmacology Categories for Review ...........................................................................282
Exam Prep Questions ....................................................................................................283
Answer Rationales.................................................................................................285
Suggested Reading and Resources ................................................................................286
CHAPTER 16
Caring for the Maternal/Infant Client.....................................................................287
Signs of Pregnancy ........................................................................................................288
Presumptive Signs ................................................................................................288
Probable Signs ......................................................................................................288
Positive Signs ........................................................................................................289
Prenatal Care .................................................................................................................289
Prenatal Diet and Weight Maintenance ..............................................................289
Alpha-Fetoprotein Screening...............................................................................289
Other Prenatal Diagnostic Tests ..........................................................................290
Assessing Fetal Heart Tones.................................................................................291
Ultrasonography ...................................................................................................291
Signs of Complications of Pregnancy ...........................................................................291
Types of Abortions.........................................................................................................292
Complications Affecting Pregnancy..............................................................................292
Diabetes in Pregnancy..........................................................................................293
Preeclampsia .........................................................................................................293
Disseminated Intravascular Coagulation .............................................................294
Cord Prolapse .......................................................................................................295
Abruptio Placenta .................................................................................................295
Placenta Previa......................................................................................................295
Maternal Infections........................................................................................................295
Preterm Labor ...............................................................................................................299
Intrapartal Care..............................................................................................................299
Stages of Labor.....................................................................................................300
Phases of Labor ....................................................................................................300
Important Terms You Should Know....................................................................300
Prelabor Testing.............................................................................................................302
Fetal Monitoring............................................................................................................303
Pharmacologic Management of Labor .........................................................................305
Postpartum Care............................................................................................................306
Terms Associated with the Normal Newborn ..............................................................306
Rh Incompatibility.........................................................................................................307
Contraception ................................................................................................................308
Diagnostic Tests for Review ..........................................................................................310
Pharmacology Categories for Review ...........................................................................310
Exam Prep Questions ....................................................................................................311
Answer Rationales.................................................................................................313
Suggested Reading and Resources ................................................................................314
CHAPTER 17
Caring for the Pediatric Client ............................................................................315
Growth and Development.............................................................................................316
Infant (28 Days to 1 Year) ....................................................................................316
Toddler (1–3 Years)...............................................................................................318
Preschooler (3–5 Years) ........................................................................................319
School Age (6–12 Years) .......................................................................................320
Adolescence (12–18 Years)....................................................................................321
Congenital Anomalies....................................................................................................321
Anomalies of the Gastrointestinal System...........................................................322
Anomalies of the Musculoskeltal System.............................................................326
Anomalies of the Cardiovascular System.............................................................328
Inborn Errors of Metabolism...............................................................................331
Respiratory Disorders....................................................................................................332
Acute Otitis Media ...............................................................................................333
Tonsillitis...............................................................................................................334
Laryngotracheobronchitis ....................................................................................335
Acute Epiglottitis..................................................................................................335
Bronchiolitis..........................................................................................................336
Cystic Fibrosis (Mucoviscidosis) ..........................................................................337
Gastrointestinal Disorders.............................................................................................337
Gastroenteritis ......................................................................................................338
Pyloric Stenosis.....................................................................................................338
Intussusception .....................................................................................................338
Celiac (Gluten-Induced Enteropathy, Celiac Sprue) ..........................................339
Cardiovascular Disorders ..............................................................................................339
Rheumatic Fever...................................................................................................339
Kawasaki’s Disease (Mucocutaneous Lymph Node Syndrome) .........................340
Musculoskeletal Disorders.............................................................................................342
Scoliosis.................................................................................................................342
Legg-Calve-Perthes Disease (Coxa Plana) ..........................................................343
Muscular Dystrophies...........................................................................................343
Childhood Cancer .........................................................................................................344
Wilms Tumor (Nephroblastoma) ........................................................................344
Leukemia...............................................................................................................344
Osteogenic Sarcoma (Osteosarcoma) ..................................................................344
Ingestion of Hazardous Substances...............................................................................345
Salicylate Overdose...............................................................................................345
Acetaminophen (Tylenol) Overdose ....................................................................345
Lead (Plumbism) ..................................................................................................345
Iron Poisoning ......................................................................................................346
Diagnostic Tests for Review ..........................................................................................346
Pharmacology Categories for Review ...........................................................................347
Exam Prep Questions ....................................................................................................348
Answer Rationales.................................................................................................350
Suggested Reading and Resources ................................................................................351
Practice Exam 1 .............................................................................................353
Answers to Practice Exam 1 ...............................................................................397
Practice Exam 2 .............................................................................................419
Answers to Practice Exam 2 ...............................................................................461
APPENDIX A Things You Forgot ...........................................................................................483
APPENDIX B Need to Know More? .......................................................................................491
APPENDIX C Alphabetical Listing of Nursing Boards in the United States and Protectorates ..................499
Glossary ......................................................................................................515
TOC, 9780789741066
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